This study aimed to fill the current gap in the understanding of the knowledge, attitudes and behaviours (KAB) related to dietary Na among adult residents in Singapore.

A cross-sectional online survey was conducted between October and December 2020 on 955 participants selected through random sampling.

The survey was conducted in Singapore.

Participants were recruited from the Singapore Population Health Study Online Panel.

Participants’ mean age was 46·6 ± 14·1 years old and 58 % of them were females. Most of the participants were Chinese (82·1 %), 10·5 % were Indian and 4·5 % were Malay. Findings from the weighted data showed that most participants were aware of the health impact of high Na consumption. However, many participants were unaware of the recommended intake for salt (68%) and Na (83%), had misconceptions, and were unable to correctly use food labels to assess NA content (69%). Findings also alluded to the presence of knowledge gaps in the sources of Na in their diet. While 59 % of the participants reported to be limiting their consumption of Na, many reported facing barriers such as not knowing how to limit their Na intake. Participants also felt that there were limited options for low-Na foods when eating out and were lacking awareness of low-Na products.

Findings highlighted substantial gaps in participants’ knowledge and skills in managing their Na consumption. This suggests the need for more public education and improvements in the food environment.

To develop and evaluate a stand-alone Elementary School-aged Children’s Index of Diet Quality (ES-CIDQ).

In this cross-sectional study, children filled in a food frequency questionnaire (FFQ) with twenty-nine multiple-item questions on the consumption of foods, portion sizes and eating frequency and a 5-d food diary. Nutrient intakes were calculated with nutrient analysis software. FFQ questions best reflecting a health-promoting diet with reference to dietary recommendations were identified by correlations, logistic regression modelling and receiver-operating characteristics curve analysis.

Southwest and Eastern Finland.

Healthy elementary school-aged volunteers [n 266, mean (sd) age 9·7 (1·7) years] were recruited between March 2017 and February 2018.

A set of questions was identified from the FFQ that best depicted the children’s diet quality as defined in the dietary recommendations. These fifteen questions were scored and formulated into a stand-alone index as a continuous index score (range 0–16·5 points) and a two-category score: good and poor diet quality. The cut-off score of six points for a good diet quality had a sensitivity of 0·60 and a specificity of 0·78. Children with a good diet quality (49·8 % of the children) had higher intakes of protein, dietary fibre, and several vitamins and minerals, and lower intakes of sucrose, total fat, SFA and cholesterol compared to children with a poor diet quality.

The developed short stand-alone index depicted diet quality as defined in the dietary recommendations. Thus, ES-CIDQ may be used for assessing diet quality in Finnish elementary school-aged children in school health care and nutrition research.

To quantify associations between four types of social support and measured adiposity among women and men.

The cross-sectional sample from the Canadian Longitudinal Study on Aging (CLSA, 2012–2015). Height, weight and waist circumference (WC) were clinically measured, and perceived availability of informational, tangible, emotional and belonging social supports was self-reported.

Canada.

28 779 adults aged 45–85 years from the CLSA.

All social support types were associated with WC and BMI among women but not among men. Women reporting the lowest informational support had significantly higher mean BMI (28·84 kg/m2 (95 % CI 28·63, 29·05)) and WC (90·81 cm (95 % CI 90·31, 91·30)) compared with women reporting maximum support (respectively, 28·09 kg/m2 (95 % CI 27·88, 28·30) and 88·92 cm (95 % CI 88·43, 89·4)). Women’s abdominal obesity was associated with low levels of informational, emotional and belonging support, and women’s general obesity with informational and emotional support. Notably, informational and emotional support were associated with both obesity outcomes independent of other supports among women. Only a low level of informational support was significantly independently associated with higher odds of obesity among men.

Our study provides novel insights into gender-specific associations between different types of social support and adiposity. Prospective studies are needed to further investigate potential causality of these associations between the specific social supports and future weight status, especially among women.

To examine associations between household food insecurity and children’s physical activity and sedentary behaviours.

Secondary analysis was conducted on the Healthy Communities Study, an observational study from 2013 to 2015. Household food insecurity was assessed by two items from the US Department of Agriculture’s 18-item US Household Food Security Survey Module. Physical activity was measured using the 7-d Physical Activity Behaviour Recall instrument. Data were analysed using multilevel statistical modelling.

A total of 130 communities in the USA.

In sum, 5138 US children aged 4–15 years.

No associations were found for the relationship between household food insecurity and child physical activity. A significant interaction between household food insecurity and child sex for sedentary behaviours was observed (P = 0·03).

Additional research capturing a more detailed assessment of children’s experiences of food insecurity in relation to physical activity is warranted. Future studies may consider adopting qualitative study designs or utilising food insecurity measures that specifically target child-level food insecurity. Subsequent research may also seek to further explore sub-group analyses by sex.

To assess whether parent-reported time and cost for provision of food is associated with consumption of fruits, vegetables and non-core foods in pre-schoolers.

Cross-sectional analysis of baseline data from the Healthy Habits randomised controlled trial. Two subscales of the Children’s Dietary Questionnaire (CDQ) were used to assess fruit and vegetable, and non-core food consumption.

Thirty pre-schools in the Hunter Region of New South Wales, Australia.

Parents (n 396) with a child aged 3–5 years attending a participating pre-school were recruited. Parents needed to reside with that child for at least four days per week and have primary responsibility for providing meals and snacks to their child.

Sixty-three per cent of children had a parent-reported subscale score indicating adherence to dietary guidelines for fruit and vegetable intake, while 64% of children had a subscale score indicating they were exceeding dietary guidelines for non-core foods. Regression models revealed significant positive associations between higher CDQ scores for non-core foods (indicating higher consumption levels) and minutes that parents spent preparing food (P=0·032 and 0·025) and amount spent on purchasing food (P=0·043 and 0·020). The magnitude of the effects was small (estimate=0·003 and 0·001).

Time and cost spent by parents on provision of food was not significantly associated with child fruit and vegetable consumption. Further explorations into time spent on food preparation and cost of food procurement are warranted to help address the increased consumption of non-core foods by pre-school children.

To quantify PUFA-associated improvement in linear growth among children aged 6–10 years.

Serum fatty acids (FA), including essential FA (EFA) (linoleic acid (LA) and α-linolenic acid (ALA)) were quantified at baseline using GC-MS technology. FA totals by class (n-3, n-6, n-9, PUFA and SFA) and FA ratios were calculated. Height-for-age Z-score (HAZ) relative to WHO population reference values were calculated longitudinally at baseline, 6 and 12 months. Linear regression models estimated PUFA, HIV status and their interaction-associated standardised mean difference (SMD) and 95 % CI in HAZ over 12 months.

Community controls and children connected to community health centre in Kampala, Uganda, were enrolled.

Children perinatally HIV-infected (CPHIV, n 82), or HIV-exposed but uninfected (CHEU, n 76) and community controls (n 78).

Relative to highest FA levels, low SFA (SMD = 0·31, 95 % CI: 0·03, 0·60), low Mead acid (SMD = 0·38, 95 % CI: 0·02, 0·74), low total n-9 (SMD = 0·44, 95 % CI: 0·08, 0·80) and low triene-to-tetraene ratio (SMD = 0·42, 95 % CI: 0·07, 0·77) predicted superior growth over 12 months. Conversely, low LA (SMD = -0·47, 95 % CI: −0·82, −0·12) and low total PUFA (sum of total n-3, total n-6 and Mead acid) (SMD = -0·33 to −0·39, 95 % CI: −0·71, −0·01) predicted growth deficit over 12 months follow-up, regardless of HIV status.

Low n-3 FA (ALA, EPA and n-3 index) predicted growth deficits among community controls. EFA sufficiency may improve stature in school-aged children regardless of HIV status. Evaluating efficacy of diets low in total SFA, sufficient in EFA and enriched in n-3 FA for improving child growth is warranted.

The present study provides ranges for the magnitude of bias caused by measurement error in stunting rates, a widely used a proxy for long-term nutritional status.

Stunting, which is determined by the number of cases that fall below −2 sd from the mean height-for-age in the population, mechanically increases with higher variance. This variance stems from both natural heterogeneity in the population and measurement error. To isolate the effect of measurement error, we model the true distributions which could give rise to the observed distributions after subtracting a simulated measurement error.

We analyse information from three rounds of the Demographic and Health Survey (DHS) in Egypt (2005, 2008 and 2014). Egypt ranks high among developing countries with low-quality anthropometric data collected in the DHS, currently the main source of anthropometry in the country.

The study relies on re-analysis of existing DHS data, which record height, weight and age data for children under 5 years old.

Under the most conservative assumptions about measurement error, the stunting rate falls by 4 percentage points for the most recent DHS round, while assuming higher levels of measurement error reduces the stunting rate more dramatically.

Researchers should be aware of and adjust for data quality concerns in calculating stunting rates for cross-survey comparisons or in communicating to policy makers.

To assess the comprehensiveness (scope of nutrition guidance) and strength (clarity of written language) of centre-based nutrition policies (CBNP) within early childhood education (ECE) centres. To also consider the applicability of an existing CBNP assessment tool and policy alignment with best practice food provision and feeding practices.

Cross-sectional online study to assess written ECE CBNP using the Wellness Child Care Assessment Tool.

Licenced ECE centres in the state of Victoria, Australia.

ECE centres (operating at least 8 h per d, 48 weeks per annum), stratified by location (rural and metropolitan), centre management type (profit and not-for-profit) and socio-economic area (low, middle, high).

Included individual CBNP (n 118), predominantly from metropolitan centres (56 %) and low-medium socio-economic areas (78 %). Policies had low overall Wellness Child Care Assessment Tool scores, particularly strength scores which were low across all four domains (i.e. nutrition education, nutrition standards, health promotion and communication/evaluation). The nutrition standards domain had the lowest strength score. The communication/evaluation domain had the lowest comprehensiveness score. Content analysis indicated low scores may relate to the Wellness Child Care Assessment Tool applicability for the Australian context due to differences in best practice guidance.

Despite the presence of written nutrition policies in ECE centres, many showed weak language and lacked comprehensiveness and strength. This may relate to poor implementation of best practice food provision or feeding practices. Low scores, however, may partly stem from using an assessment tool that is not country-specific. The redevelopment of country-specific tools to assess ECE CBNP may be warranted.

Telomere length (TL) is a posited pathway through which chronic stress results in biological dysregulation and subsequent adverse health outcomes. Food insecurity is associated with shorter TL. Social support, which is defined by the size and function of an individual’s social network, is associated with better health outcomes. The present study assesses whether social support modifies the relationship between food security and TL.

Cross-sectional study design. Linear regression was used to assess the association between food insecurity and TL, stratified by social support level. A multiplicative interacted model was used to formally test modification.

Data come from the National Health and Nutrition Examination Survey 1999–2000 and 2001–2002 waves.

Adults aged 60 years and older who have measurements for TL.

Our sample comprised 2674 participants, and 63·5 % of the total sample had low social support, with 13·3 % being food insecure. In fully adjusted models, food insecurity was negatively though modestly associated (P = 0·13) with TL. Associations between food insecurity and TL were significantly modified by social support (interaction P = 0·026), whereby food insecurity had a stronger effect among individuals with high social support (coefficient = –0·099 (95 % CI: –0·161, –0·038)) compared to low social support (coefficient = –0·001, (95 % CI: –0·033, 0·032)).

Food insecurity is modestly associated with shorter TL. Contrary to our hypothesis, food insecurity had more deleterious effects on TL among participants with high social support than low social support. Results may indicate that the food insecure population is a higher needs population, and increased social support reflects these needs rather than providing protective effects.

To examine parents’/caregivers’ willingness to participate and willingness to pay (WTP) for a cost-shared school food program (SFP) and its associated factors.

A quantitative survey design was used where WTP for a hypothetical SFP was elicited using a double-bounded dichotomous choice elicitation method. We used a double hurdle (logistic and truncated regression) model to examine WTP and positively or negatively associated factors.

Saskatoon Public School Division elementary schools situated in high-, mid- or low-median-income neighbourhoods.

Parents or caregivers of children attending grades 1 to grade 8 in the Saskatoon Public School Division elementary schools.

94 % respondents were willing to participate in a SFP while less than two-thirds of participants were willing to pay for such a program. Over 90 % respondents from all the socio-economic groups were willing to participate. Multiple household income earners, higher household income, higher number of children, household food security status and higher academic attainment of parents’/caregivers predicted greater willingness to pay. Mean willingness to pay was $4·68 (CAN), and households reporting moderate or severe food insecurity were likely to be willing to pay significantly less for a SFP.

A cost-shared program might be financially sustainable in Canada if community characteristics such as household food insecurity status, economic participation of women and average household size are kept in mind while determining the price of the program.

Higher BMI, lower quality of diet and a higher percentage of breakfast-skippers have been reported among rotating shift (RS) workers compared with day shift (DS) workers. As such, this study examined the association between breakfast skipping, habitual food consumption and BMI in RS workers.

Japanese nurses were studied using a self-administered questionnaire that assessed the height, weight, breakfast consumption habits, dietary consumption, physical activity, sleep habits, chronotype and demographic characteristics of the participants.

A cross-sectional study was conducted in a population of nurses in Japan. Dietary and health-related questionnaires were mailed to 5536 nurses aged 20–59 years, working at 346 institutions.

A total of 3646 nurses at 274 institutions responded to the questionnaire. After removing those who met the exclusion criteria, 2450 participants were included in the statistical analysis.

The RS breakfast-skippers had lower total energy intake, diet quality and higher BMI than DS workers, whereas the RS breakfast-consumers had a higher total energy intake and BMI than the DS workers. In the RS workers, breakfast skipping on the days of DS and the end days of evening/night shift was associated with a poorer diet quality. Additionally, breakfast skipping on the days of DS was positively associated with BMI, independent of the total energy intake and diet quality.

Breakfast skipping on workdays may contribute to a difference in dietary intake and BMI between RS workers and DS workers and may increase BMI in RS workers, independent of dietary intake.

Test effects of a standardised front-of-package (FOP) disclosure statement (indicating added sugar, non-nutritive sweetener (NNS) and juice content) on accuracy in assessing ingredients and perceived healthfulness of children’s drinks.

In two randomised controlled experiments, the same participants viewed drink packages and indicated if products contained added sugar or NNS and percent juice and rated drink healthfulness. Experiment 1 (E1) included novel (non-US) children’s drinks with a) product claims only (control), b) claims and disclosure, or c) disclosure only. Experiment 2 (E2) included existing children’s drinks (with claims) with a) no disclosure (control) or b) disclosure. Both experiments evaluated sweetened (fruit drink and flavoured water) and unsweetened (100 % juice and juice/water blend) drinks. Potential individual differences (education level and race/ethnicity) in effects were explored.

Online survey

Six hundred and forty-eight US caregivers of young children (1–5 years)

FOP disclosures significantly increased accuracy for most ingredients and drink types, including identifying presence or absence of NNS in sweetened drinks, no added sugar in juice/water blends, and actual percent juice in fruit drinks and juice/water blends in both experiments. Disclosures also increased recognition that the novel 100 % juice and juice/water blend did not contain NNS or added sugar (E1) and existing sweetened drinks contained added sugar (E2). Disclosures reduced perceived healthfulness of sweetened drinks but did not increase unsweetened drink healthfulness ratings. Some differences by participant socio-demographic characteristics require additional research.

FOP disclosures on children’s drink packages can increase caregivers’ understanding of product ingredients and aid in selecting healthier children’s drinks.

Elevated BMI is associated with multiple chronic conditions including diabetes and CVD. Patients with overweight or obesity may also suffer from comorbidities not directly related to the pathophysiology of elevated BMI. The current study sought to determine the impact of BMI and different types of chronic conditions on health-related quality of life (HRQoL) outcomes.

Six weight categories by BMI were identified: underweight, normal weight, overweight, Class-I obesity, Class-II obesity and Class-III obesity. Twenty chronic conditions were considered and categorised as elevated BMI-related (concordant) or -unrelated (discordant) conditions. HRQoL outcomes were measured using Short Form-6 Dimensions (SF-6D). Multivariable regression models were performed to examine the impact of type, number of comorbid conditions and BMI categories on SF-6D scores.

Medical Expenditure Panel Survey (2013–2015).

Nationally representative sample of US population; 18 years or older (n 58 960).

Of the sample, 1·7 %, 32·9 %, 34·0 % and 31·4 % were classified as underweight, normal weight, overweight and obese, respectively. The SF-6D scores were significantly decreased across all obesity classes, with the largest reduction in Class-III obesity (0·033; P < 0·001). Additionally, individuals with obesity having one or more concordant or discordant comorbidities further reduced SF-6D scores between 0·031 and 0·148 (P-values < 0·001) or between 0·080 and 0·212 (P-values < 0·001), respectively.

Individuals with obesity had a significant reduction in HRQoL outcomes compared to those with normal BMI. Importantly, discordant comorbidity resulted in greater reduction in HRQoL outcomes compared to concordant comorbidity in subjects with elevated BMI.

To investigate whether financial constraint and perceived stress modify the effects of food-related taxes on the healthiness of food purchases.

Moderation analyses were conducted with data from a trial where participants were randomly exposed to: a control condition with regular food prices, an sugar-sweetened beverage (SSB) tax condition with a two-tiered levy on the sugar content in SSB (5–8 g/100 ml: €0·21 per l and ≥8 g/100 ml: €0·28 per l) or a nutrient profiling tax condition where products with Nutri-Score D or E were taxed at a 20 percent level. Outcome measures were overall healthiness of food purchases (%), energy content (kcal) and SSB purchases (litres). Effect modification was analysed by adding interaction terms between conditions and self-reported financial constraint or perceived stress in regression models. Outcomes for each combination of condition and level of effect modifier were visualised.

Virtual supermarket.

Dutch adults (n 386).

Financial constraint or perceived stress did not significantly modify the effects of food-related taxes on the outcomes. Descriptive analyses suggest that in the control condition, the overall healthiness of food purchases was lowest, and SSB purchases were highest among those with moderate/high levels of financial constraint. Compared with the control condition, in a nutrient profiling tax condition, the overall healthiness of food purchases was higher and SSB purchases were lower, especially among those with moderate/high levels of financial constraint. Such patterns were not observed for perceived stress.

Further studies with larger samples are recommended to assess whether food-related taxes differentially affect food purchases of subgroups.

To evaluate the association between the consumption of NOVA food groups (classification based on the nature, extent and purpose of food processing) and the intake of energy, macro and micronutrients among school children.

Cross-sectional study. Food consumption was assessed by two 24-h dietary recalls on non-consecutive days. Energy from each NOVA food groups – ultra-processed foods, unprocessed or minimally processed foods, processed culinary ingredients and processed foods – was estimated. For analysis, the percentage of energy from ultra-processed foods and unprocessed or minimally processed foods were categorised into tertiles and associated with intake of energy, macro and micronutrients using analysis of covariance and linear regression.

Public schools in Belo Horizonte, Minas Gerais, Brazil.

School children aged 8–12 years (n 797; 406 girls; 391 boys).

Mean energy intake was 2050·18 ± 966·83 kcal/d, 25·8 % was from ultra-processed foods, 56·7 % from unprocessed or minimally processed foods, 8·9 % from processed culinary ingredients and 8·6 % from processed foods. A higher energy contribution from ultra-processed foods was negatively associated with the intake of protein, fibre, vitamin A, Fe and Zn (P < 0·001) and positively associated with total energy, lipid and Na intake (P < 0·001). Concurrently, a higher energy contribution from unprocessed or minimally processed foods was positively associated with the consumption of protein, fibre, Fe and Zn (P < 0·001) and negatively associated with total energy (P = 0·002), lipid and Na intake (P < 0·001).

In conclusion, higher ultra-processed food consumption presented a negative association with the nutrient intake profile of school children.

Behavioural patterns are important in understanding the synergistic effect of multiple health behaviours on childhood adiposity. Most previous evidence assessing associations between patterns and adiposity were cross-sectional and investigated two or three behaviour domains within patterns. This study aimed to identify behavioural patterns comprising four behaviour domains and investigate associations with adiposity risk in children.

Parent-report and accelerometry data were used to capture daily dietary, physical activity, sedentary behaviour and sleep data. Variables were standardised and included in the latent profile analysis to derive behavioural patterns. Trained researchers measured children’s height, weight and waist circumference using standardised protocols. Associations of patterns and adiposity measures were tested using multiple linear regression.

Melbourne, Australia.

A total of 337 children followed up at 6–8 years (T2) and 9–11 years (T3).

Three patterns derived at 6–8 years were broadly identified to be healthy, unhealthy and mixed patterns. Patterns at 9–11 years were dissimilar except for the unhealthy pattern. Individual behaviours characterising the patterns varied over time. No significant cross-sectional or prospective associations were observed with adiposity at both time points; however, children displaying the unhealthy pattern had higher adiposity measures than other patterns.

Three non-identical patterns were identified at 6–8 and 9–11 years. The individual behaviours that characterised patterns (dominant behaviours) at both ages are possible drivers of the patterns obtained and could explain the lack of associations with adiposity. Identifying individual behaviour pattern drivers and strategic intervention are key to maintain and prevent the decline of healthy patterns.

To investigate the relationship between the dietary approaches to stop hypertension (DASH)-style dietary patterns in childhood and cardiometabolic risk (CMR) in adolescence/early adulthood.

Data were obtained from the Avon Longitudinal Study of Parents and Children (ALSPAC) prospective cohort. Diet diary data collected at 7, 10 and 13 years were used to calculate DASH-style diet scores (DDS). Multivariable linear regression models were used to investigate the associations between the DDS at 7, 10 and 13 years and CMR scores, calculated at 17 and 24 years.

The ALSPAC cohort included children born in south-west England in 1991–1992.

Children with complete dietary, covariate and cardiometabolic data at 17 (n 1,526) and 24 years (n 1,524).

A higher DDS at 7 and 10 years was negatively associated with CMR scores at 17 years (β = –0·64 (95 % CI –1·27, –0·006), Ptrend=0·027 for fifth v. first DDS quintile at 7 years; β = –0·73 (95 % CI –1·35, –0·12) and Ptrend=0·037 for fifth v. first DDS quintile at 10 years) and at 24 years (β = –0·92 (95 % CI –1·49, –0·34) Ptrend = 0·001 for fifth v. first DDS quintile at 7 years; β = –0·60 (95 % CI –1·20, –0·05) Ptrend = 0·092 for fifth v. first DDS quintile at 10 years). No associations were found between the DDS at 13 years and CMR score at 17 and 24 years.

Greater adherence with a DASH-style diet during childhood was associated with better cardiometabolic health in adolescence/adulthood in the ALSPAC cohort. The components of the DASH diet could be recommended to improve children’s cardiometabolic health.

To investigate whether food insecurity helps explain the association between income and psychological distress and if its role differs by disability status.

Using 2011–2017 National Health Interview Survey cross-sectional data (n 102 543), we conducted linear regression models, fully interacted with disability status, to estimate the association between income-to-poverty ratio (IPR) (<1, 1–<2, 2–<4, ≥4) and psychological distress (Kessler 6 (K6) Scale, range: 0–24). Base models adjusted for socio-demographic factors. We then added food security (secure, low and very low), interacted with disability, and conducted post-estimation adjusted Wald tests.

USA.

Nationally representative sample of non-institutionalised adults 18 years and older.

The association between income and psychological distress was stronger for people with disabilities. Compared to those in the highest income category (IPR ≥4), poor individuals (IPR < 1) with and without disabilities scored 2·10 (95 % CI (1·74, 2·46)) and 0·81 (95 % CI (0·69, 0·93)) points higher on the K6 Scale, respectively. Accounting for food insecurity reduced the estimated income disparity in psychological distress significantly more among individuals with disabilities (0·96 points or 46 %) than without disabilities (0·34 points or 42 %), decreasing the difference in the income disparity between those with and without disabilities by 48 % (0·62 points). Further, food insecurity more strongly predicted psychological distress for individuals with disabilities independent of socio-economic disadvantage.

Food insecurity plays a more important role in shaping patterns of psychological distress for people with disabilities, explaining more of the association between income and psychological distress among those with than without disabilities. Improving food security may reduce mental health disparities.